800-826-HOPE (4673)

Breast Cancer

Overview

City of Hope treated me as a person. I wasn’t just a patient, a chart. I mattered.”  Kommah, breast cancer survivor

If you have been recently diagnosed with breast cancer, or you've been told you may be at high risk of developing it, talk to the specialists at City of Hope. Our integrated team of professionals will guide you and your loved ones through each step of the journey, from diagnosis to treatment to recovery and survivorship.

We will answer your questions, calm your concerns and design a personalized treatment plan to give you the best possible outcome.

Request a Consultation

If you have been diagnosed with breast cancer, are at a high risk for developing breast cancer or are looking for a second opinion consultation about your treatment, you may request an appointment online or contact us at 800-826-4673 (HOPE). Please visit Making Your First Appointment for more information.

City of Hope has been named a best hospital for cancer by U.S. News & World Report for over a decade and a National Cancer Institute comprehensive cancer center, the highest designation that recognizes our commitment to cancer treatment, research and education.

As a founding member of the National Comprehensive Cancer Network, our doctors also help develop and improve evidence-based breast cancer treatment guidelines for patients throughout the country.

Highlights of our breast cancer program include:

  • A personalized treatment approach guided by your unique needs and background, including molecular and genetic testing of your cancer to find the most effective therapies
  • Our leadership and experience in minimally invasive and complex surgeries – such as combining cancer removal and breast reconstruction in one operation
  • Highly precise radiation therapy delivery that can target the breast tumor better while minimizing exposure to normal breast tissue
  • A wide portfolio of drugs that can fight cancer better with fewer side effects
  • Ongoing research and clinical trials of promising new therapies and ways to predict for benefit from treatment
  • A comprehensive supportive care program to address a wide range of cancer - and treatment-related concerns
  • Tests, consultations and treatments are coordinated and provided at our Women’s Center for greater convenience
  • Long-term survivorship and follow-up program focused on minimizing recurrence risk and improving quality of life
  • Identifying tumor markers to predict for benefits from treatment
  • Breast cancer risk assessment based on genetics, personal, lifestyle and environmental factors

NEWS & BREAKTHROUGHS

What is breast cancer?

Breast cancer is a disease in which breast tissue cells start growing abnormally and uncontrollably.

  • The most common form of breast cancer is ductal carcinoma, which begins with cells in the breast ducts, tubes that carry breast milk to the nipple.
  • Less common forms of breast cancer include lobular carcinoma, which begins in the lobules – tissues that make breast milk – and inflammatory breast cancer, which causes the breast to become red, swollen and abnormally warm.
  • Rare forms of breast cancer include those in other types of cells (such as lymph/blood vessels or connective tissues within the breast) and breast cancer in men.
  • Additionally, patients may also be diagnosed with ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS) in which cells have undergone cancerous changes but are confined within the breast duct or lobule, respectively. DCIS and LCIS are also known as breast pre-cancers or “Stage 0 breast cancer.”

What increases your risk of breast cancer?

Factors that can elevate risk breast cancer risk include:

  • A personal or family history of breast cancer, including DCIS and LCIS
  • Inherited genetic predispositions, most commonly with BRCA1 or BRCA2 gene mutations
  • Elevated lifetime estrogen exposure, including:
    • Early onset of menstruation (before age 11)
    • Late onset of menopause (after the age of 55)
    • Older age of first childbirth (after age of 30) or never having given birth
    • Taking estrogen and progesterone after menopause
  • Having dense breast tissue
  • Obesity
  • Prior radiation therapy to the chest area
  • Consuming alcohol, especially in excess of two drinks a day
  • Age: Two-third of invasive breast cancers are found in women 55 or older
  • Race and ethnicity: Caucasian women are more likely to be diagnosed with breast cancer, but African-American women are more likely to die from this disease. African-American women are also more likely to be diagnosed at a younger age (under 45).

Research has also shown that a healthy lifestyle and maintenance of a normal weight, including a well-balanced diet and regular exercise, may reduce breast cancer risk.

Breast cancer risk may also be reduced by prophylactic methods, such as taking estrogen blockers, and undergoing a mastectomy and/or oophorectomy (surgical removal of the breasts and ovaries, respectively.) These methods are typically for women with a greatly elevated risk of developing breast cancer, such as BRCA mutation carriers.

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What are the symptoms of breast cancer?

The most common symptoms of breast cancer include:

  • Feeling a lump in the breast area, with or without pain
  • Change in breast shape or size
  • Dimple or puckering in breast
  • A nipple turning inward into the breast
  • Nipple discharge other than breast milk, especially if it is bloody
  • Scaly, red, darkened or swollen skin in the breast area
  • Itchy, scaly sore or rash on the nipple
  • Dimple, pitted appearance or feel (similar to an orange peel) in the breast area
  • Swollen or enlarged lymph nodes around the breast area, including the collarbone and armpits

Although these symptoms can be caused by other conditions, you should check with a doctor – preferably a breast health specialist – so they can make a definitive diagnosis.

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Sources: National Cancer Institute and American Cancer Society

Diagnosing Breast Cancer

Precise breast cancer tests are crucial for treatment planning, and City of Hope is equipped with state-of-the-art technologies and specialized staff to ensure an accurate, comprehensive diagnosis of breast cancer.

Highlights of our screening and diagnosis services include:

  • 3-D mammography to better detect and locate breast cancer
  • Genetic screening, testing and counseling for women with high breast cancer risk
  • Magnetic resonance imaging (MRI) and ultrasound for women with dense breasts or elevated risk
  • Stereotactic biopsy, which uses computer-assisted imaging to accurately guide removal of suspicious tissue

Many of these tests are conveniently offered at our Women’s Center.

How is breast cancer detected?

Once you notice changes in your breast, or as part of a routine breast screening, your doctor may use the following tests to look for breast cancer:

  • Physical exam
  • Clinical breast examination
  • Mammogram: An X-ray of the breast
  • Ultrasound: Imaging the breast using high-energy sound waves
  • Magnetic resonance imaging (MRI): Imaging the breast using radio waves, magnetic fields and computer imaging; more powerful and detailed than a mammogram, this test is recommended for women with above-average breast cancer risk
  • Biopsy: Surgical removal of suspicious tissues for further examination
  • Genetic screening: Women with elevated risk factors (such as a family history of breast cancer) may undergo genetic screening to see if they have mutations that put them at higher risk for developing the disease

If cancer is found, additional tests are performed to determine the type and stage of disease. These diagnostic tests include:

  • Receptor testing: These tests examine the cancerous tissue to see if the growth of the cancer is driven by hormones, estrogen and progesterone, or the growth factor called HER2/neu, or if it is nonresponsive to all three (also known as triple negative breast cancer). The results can then be used to determine what hormone or drug therapies are most effective against the disease.
  • Genetic testing: The cancerous tissue is tested to see if it exhibits certain genetic mutations (such as the BRCA1 and BRCA2 genes), which can be used to determine better treatments or identify risk for other cancers – allowing more aggressive screening and surveillance.
  • Computed tomography (CT or CAT) scan: This test involves taking a series of X-ray images to form a computer-generated image, which determines tumor size, location and number. Special dyes may be used to enhance this scan.
  • Lymph node biopsy: Removal and examination of lymph nodes near the breast to see if the cancer has spread.
  • Chest X-ray: An X-ray of the chest area to determine size, location and number of tumors.
  • Bone scan: A procedure using a small amount of radioactive material to determine if breast cancer cells have spread to the bones.
  • Positron emission tomography (PET) scan: A test that uses a small amount of radioactive glucose material and a PET scanner to locate cancer cells throughout the body.

Based on the results of these tests, the breast cancer is then staged according to its size, number of lymph nodes affected and whether it has spread to nearby or distant organs.

What are the current screening guidelines for breast cancer?

The current American Cancer Society screening recommendations for women with average breast cancer risk are:

  • Women between ages 40 to 44 should consider beginning annual mammograms.
  • Women between ages 45 to 54 should get annual mammograms.
  • Women age 55 or older should switch to mammograms every two years, or have the choice to continue annual screening.

For women with high breast cancer risk, the American Cancer Society recommends:

  • Beginning annual screening mammograms at an earlier age
  • Screening with MRI in addition to annual mammograms

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Breast cancer treatment options

City of Hope provides cutting edge, compassionate treatment with a team approach where the patient and her family are at the center of the team.”  Joanne Mortimer, M.D., Director, Women’s Cancers Program

Your breast cancer is every bit as unique as you are, and that is why breast cancer treatment at City of Hope is focused around you and your loved ones.

This means our physicians will personally consult with you about your disease, treatment options and desired outcomes. Afterward, our multidisciplinary team of specialists will work together to discuss, design and deliver an individual treatment plan to best meet those goals.

The innovative treatments we use to treat breast cancer include:

Surgery

Not only do I help women take care of their breast cancer, but I also try to make it look like no one has been there.”  Laura Kruper, M.D., M.S., Chief, Breast Surgery Service

Surgery is a common treatment option for most breast cancer patients. Depending on the tumor’s size, location and spread, the procedure performed may be a lumpectomy (removal of the tumor, surrounding breast tissue and possibly nearby lymph nodes) or a mastectomy (removal of one or both breasts, along with nearby lymph nodes). Mastectomies may also be performed as a risk reduction procedure for women with a high risk of developing breast cancer.

City of Hope offers the latest advances in surgical approaches to treating breast cancer. Our leading-edge technology and our surgeons’ expertise means you can achieve outstanding outcomes that are not possible elsewhere. This includes breast cancer surgeries with fewer and smaller incisions, reducing discomfort and recovery time. Our minimally-invasive approach also allows patients to be treated sooner with post-surgery treatments, such as follow-up radiation and drug therapy.

Our team is also experienced in breast-conserving surgery, which can remove early stage tumors while achieving excellent cosmetic outcomes. This procedure can be done with larger tumors as well, by shrinking the tumor with chemotherapy before the surgery.

For more extensive procedures, our breast surgeons will work in conjunction with our plastic surgery team. This includes combining skin- and nipple-sparing mastectomies with breast reconstruction in one operation, preserving or restoring breast appearance without compromising health outcomes.

Our plastic surgery team can also offer reconstruction options – with either breast implants or your own tissue – to a wide range of breast cancer patients. These include:

  • patients who have had mastectomies in the past
  • patients with larger breasts or a higher body mass index, or BMI
  • patients who are dissatisfied with their previous reconstructions

For patients who have a high risk of developing breast cancer, these appearance-preserving or appearance-restoring techniques may also be used after risk reduction surgeries.

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Radiation Therapy

Radiation therapy uses high-energy X-rays or other forms of radiation to kill cancer cells. It may be delivered externally using focused beams of energy, or internally, placing an energy emitting substance in or near the tumor site at the time of surgery.

City of Hope is a leader in image-driven radiation planning, using computed tomography and magnetic resonance imaging scans to determine tumor size and location. This ensures radiation is accurately delivered to the tumor site, while minimizing exposure to nearby normal tissues.

In addition to standard radiation therapy, which takes place daily over six or seven weeks, patients may also be eligible for hypofractionated radiotherapy – which delivers a higher dose of radiation in a shorter amount of time (four weeks), allowing patients to make fewer visits for treatment and recover faster.

Select breast cancer patients may also be eligible for intraoperative radiation therapy (IORT), which delivers high dose radiation treatment at the time of their breast cancer surgery. This procedure allows patients to skip the usual six-week cycle of radiation following lumpectomy, and may reduce radiation exposure to normal breast tissue.

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Drug Therapy

Drug therapy may be given to patients to fight breast cancer cells throughout the body by killing the cancer cells or stopping their growth and spread. These drugs include:

  • Chemotherapy, which targets all rapidly-dividing cells, including breast cancer cells
  • Targeted therapy, which selectively attacks cancer cells based on specific characteristics
  • Immunotherapy, which stimulates the patient’s own immune system to attack the cancer cells

Drugs may also be prescribed to treat conditions related to breast cancer, such as minimizing bone loss and fracture risk if the cancer has spread to the bones.

The drug or drug combination used depends on the type and stage of breast cancer, previous treatments used, the patient’s health and overall treatment goals. This personalized medicine approach may be further enhanced by molecular or genetic testing of your cancer, which can help identify treatments that are more effective and with fewer side effects.

City of Hope has a wide portfolio of cancer-fighting drugs available in its on-site pharmacy, allowing our medical oncologists to plan and prescribe a drug regimen that can best fight breast cancer while minimizing side effects.

In addition to standard drug treatments, patients may also be eligible for new, promising drugs through our clinical trials program.
 

Endocrine Therapy

Approximately two-thirds of breast cancers are reliant on the hormones, such as estrogen and/or progesterone to fuel their growth and spread, so drugs that decrease endocrine production can help slow or halt the disease. It is most often used as an adjuvant therapy (given after surgery) to reduce likelihood of cancer recurrence, but may be used in other settings as well.

In addition to standard endocrine therapy treatments, City of Hope patients have access to promising endocrine therapies through our clinical trials program. These innovative therapies may be better at treating endocrine-sensitive breast cancer and/or reduce side effects associated with endocrine therapy.

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City of Hope’s renowned physicians and researchers utilize the latest in technology and innovation to treat breast cancer, coupled with our enduring belief in providing unparalleled compassionate care.

Surgical Oncology

Laura Kruper, M.D., M.S.

Clinical Specialties

  • Surgical Oncology
  • Breast Surgery
Dawn M. Hills, M.D., F.A.C.S.

Clinical Specialties

  • Surgical Oncology
Veronica C. Jones, M.D.

Clinical Specialties

  • Surgical Oncology
  • Breast Surgery
Lesley Taylor, M.D.

Clinical Specialties

  • Surgical Oncology
  • Breast Surgery
Courtney Anne Vito, M.D.

Clinical Specialties

  • Surgical Oncology
John H. Yim, M.D.

Clinical Specialties

  • Surgical Oncology

Medical Oncology

Joanne Mortimer, M.D.

Clinical Specialties

  • Medical Oncology
Arti Hurria, M.D.

Clinical Specialties

  • Medical Oncology
Daneng Li, M.D.

Clinical Specialties

  • Medical Oncology
George Somlo, M.D.

Clinical Specialties

  • Medical Oncology
Nimit Sudan, M.D.

Clinical Specialties

  • Medical Oncology
James R. Waisman, M.D.

Clinical Specialties

  • Medical Oncology
Christina H. Yeon, M.D.

Clinical Specialties

  • Medical Oncology
Yuan Yuan, M.D., Ph.D.

Clinical Specialties

  • Medical Oncology

Radiation Oncology

Eric H. Radany, M.D., Ph.D.

Clinical Specialties

  • Radiation Oncology
Nayana L Vora, M.D.

Clinical Specialties

  • Radiation Oncology

Plastic Surgery

James S. Andersen, M.D., F.A.C.S.

Clinical Specialties

  • Plastic Surgery
Sharon Clancy, M.D.

Clinical Specialties

  • Plastic Surgery
Mark C. Tan, M.D., F.A.C.S.

Clinical Specialties

  • Plastic Surgery

Diagnostic Radiology

Lusi Tumyan, M.D.

Clinical Specialties

  • Diagnostic Radiology

Clinical Genetics

Thomas P. Slavin, M.D.

Clinical Specialties

  • Clinical Genetics
  • Medical Genetics
  • Molecular Diagnostics
Jeffrey Weitzel, M.D.

Clinical Specialties

  • Clinical Genetics
  • Clinical Cancer Genetics

Breast Cancer Research

David K. Ann, Ph.D.

Research Focus

  • Colorectal Cancer
Leslie Bernstein, Ph.D.

Research Focus

  • Cancer Etiology
  • Cancer Prevention
  • Modifiable Risk Factors in Cancer
Shiuan Chen, Ph.D.

Research Focus

  • Chemoprevention Research Program
  • Breast Cancer Translational Research
  • Program in Natural Therapies
Peter P. Lee, M.D.

Research Focus

  • Cancer and Immunity
  • Breast Cancer
  • Immunotherapy
Linda Malkas, Ph.D.

Research Focus

  • Cancer Biology
  • Peptides Directed Against Cancer Associated PCNA Has Therapeutic Potential in Breast Cancer
  • New Molecular Target for Neuroblastoma Therapy
  • NIH/NCI Cancer Center Support Grant
  • A Structure/function analysis of a tumor specific protein
  • caPep: mechanistic evaluation of an agent for neuroblastoma
  • Development of novel agents, technologies, and markers for the better diagnosis, prognosis, screening, prevention, and treatment of breast cancer
Susan L. Neuhausen, Ph.D.

Research Focus

  • Genetic epidemiology of breast and ovarian cancers
  • Etiology of prostate cancer in young men
  • Celiac disease and associated autoimmune diseases
  • Cancer etiology and outcomes - molecular and genetic aspects

Breast cancer research and clinical trials

At City of Hope, breast cancer clinicians and researchers collaborate extensively to develop and evaluate new therapies for better survival and quality-of-life outcomes. Our patients have access to a wide variety of clinical trials including new chemotherapy and targeted therapies, hormone therapies, novel surgical techniques, innovative radiation approaches and new prevention strategies.

These trials give current patients access to promising, leading-edge therapies and improve overall care for future patients worldwide. Visit our clinical trials page to learn more about current studies and their eligibility criteria.

Some of our current research projects include:

  • Decoding breast cancers’ resistance mechanisms to hormone therapy or chemotherapy so that they can be overcome, enhancing treatment effectiveness
  • Identifying and isolating breast cancer fighting compounds in natural products — such as mushrooms, pomegranates and blueberries
  • Studying the role of STAT3, a protein highly activated in cancer cells, in breast cancer and developing drugs that can target this protein
  • Better understanding genetic mutations and how they interact with one another and the environment to affect breast cancer risk
  • A population study involving more than 100,000 women to examine various lifestyle factors, such as diet and exercise, and their link to breast cancer risk
  • Improving genetic counseling and other support services for women with a high breast cancer risk, so they can be better informed and equipped to make decisions about prevention procedures, such as taking hormone blockers or undergoing risk-reducing surgeries
  • Studying survivorship with a focus on quality-of-life issues, prevention of cancer recurrence and, for premenopausal survivors, fertility concerns
  • Investigating breast cancer incidence and outcomes disparities among different populations and ways to reduce that disparity through outreach, education and screening efforts in underserved groups


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Living with breast cancer

City of Hope saved me. They saved my baby. They saved my family portrait.”  Stephanie, breast cancer survivor

When you come to City of Hope, you automatically gain access to an unparalleled array of support services to help you and your loved ones take each step during and after your breast cancer treatment.

We can help with all of the following concerns, and more:

 

Visit our Living with Cancer or Supportive Care Medicine sites for more information. For more information about the supportive care programs we offer, please contact the Sheri & Les Biller Patient and Family Resource Center at 626-218-2273 (CARE) or the Women’s Center at 800-934-5555.

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Return to Wellness Program

Already  a leader in supportive care of cancer patients, City of Hope has a new program called “Return to Wellness,” designed to tackle that big “What now?” question one topic at a time.

City of Hope experts lead workshops in nutrition, health monitoring, long-term side effect management, body image, sexuality and intimacy, lymphedema prevention, meditation, spirituality, and more. Survivors also participate in weekly strength training, restorative yoga and support group sessions.

“Return to Wellness” is a collaboration with the Cancer Support Community of Pasadena.  The program is open to women who have completed treatment for breast cancer.  Survivors need not be City of Hope patients to participate. 

Please call 626-218-CARE (2273) for more information.

Amelia, breast cancer survivor

Amelia Tena has made it her mission to become an advocate and mentor for people living with cancer.

Don Hoffman Success Story Image
Don, breast cancer survivor

Don sports his pink City of Hope breast cancer awareness pin wherever he goes – spreading the message of early detection as he enlists new recruits in his personal war on cancer.

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Homa, breast cancer survivor

“You deserve a doctor you feel confident in and who you believe is invested in your care. That’s why I chose Dr. Somlo and City of Hope.”

Kommah, breast cancer survivor

For breast cancer survivor Kommah McDowell, a second opinion at City of Hope made all the difference for her and her family…

stephanie-hosford-324x324
Stephanie, breast cancer survivor

“City of Hope saved me. They saved my baby. They saved my family portrait.”

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